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PhD Highlight | Problem Definitions and Universal Healthcare

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Sushant is currently a PhD student at the School of Public Policy and Urban Affairs with a concentration in Health Policy and Management. He is interested in various policy issues facing the healthcare sector ranging from affordability and accessibility of healthcare services to questions of technological innovation in healthcare to environmental factors that impact human health.

What sparked your interest in the particular direction of your study?
In the wake of COVID-19, millions of Americans have lost their jobs. About half the U.S population receive their health insurance through employer-sponsored coverage currently. Unemployment rates touched a record high of almost 15% in April 2020, which also led to millions of people loosing their insurance coverage along with their jobs. Although various provisions are being made to provide access to people who lost their coverage in the last few months,  the current crisis exposes the multiple limitations of the fragmented U.S healthcare system which makes access largely contingent on the employment status of a person. It was then natural for me to expect that the current crisis will strengthen the calls for a universal health insurance system. So, I decided to study the popular discourse on the idea of universal healthcare through the way two of the leading health advocacy groups, Physicians for a National Health Programme (PNHP) and Partnership for America’s Healthcare Future (P4AHCF), have been framing the idea of Medicare For All and Single-payer system, the most popular universal health insurance models floated around currently, in their recent tweets in last few years.

What sorts of adaptation, if any, have you had to make to conduct research during a pandemic?
I didn’t need to make major adjustments in my project as my chief source of data was Twitter, which allows retrieving data through writing scripts in python or R. However, I had to conduct some virtual interviews over Zoom to triangulate my findings from Twitter data, which could have otherwise happened in person. Also, all of the conversations with Professors Christopher Bosso, Jennie Stephens and David Rochefort, who guided me through the project, happened virtually over zoom which, although took some adjustments initially, didn’t change much in terms of the quality of the meetings.

Have any of your findings surprised you? How?
One of the findings that surprised me was that Partnership for America’s Healthcare Future (P4AHCF), which is a coalition of insurance providers, pharmaceutical companies, hospitals, doctors, nurses, and clinicians who oppose a Medicare for All or Single-payer healthcare system, completely stopped tweeting about Medicare For All and Single-payer system right after 11th March, 2020, the day when COVOD-19 was declared a pandemic by the WHO. After this time, P4AHCF started emphasising how their entire coalition of insurance industry, Pharma companies, hospitals, doctors and nurses were working together to fight COVID-19 and expand coverage in an apparent attempt to come across as the “good guys”. Before March 11 however, they were consistently attacking how Medicare For All and Single-payer could lead to higher taxes, lower quality of care, longer waiting times and a big government. Such a dramatic shift in narrative was absent in the case of Physicians for a National Health Programme (PNHP), a group representing more than 20,000 doctors nationwide, which supports the idea of Medicare For All and Single-payer system, whose tweets reflected the larger issues facing the American healthcare system, be it the coverage problem arising out of increasing unemployment due to economic recession or the issue of racism in healthcare in lines with the larger Black Lives Matter movement. P4AHCF’s retraction from tweeting about Medicare For All and Single-payer system indicates it’s new strategy of refraining from expressly opposing these policies in a climate when the popularity of Medicare For All and an increased role of the federal government in healthcare is increasing ever since the onset of the pandemic as reflected in various opinion polls.

How could your study help influence policy change?
Public discourse over policy issues has been a vital aspect of policy change historically as it shapes the perception of both the public and that of policymakers. An objective examination of the current discourse, taking historical lessons in to account, helps explain where the political actors stand on the issue. My study empirically finds that the PNHP, which is the group advocating for healthcare reforms, highlights the larger implications of the issues facing the American healthcare system by taking in to account issues of equity, inclusion and justice in a bid to increase their visibility by adding diverse stakeholders to their cause, as expected of a group on the loosing side of the status quo. In contrast, the opponents of health reform, the P4AHCF, use a historically time tested strategies of attacking the reform proposal by stoking public fear of big governments and losing choice and freedom under the proposed policies of Medicare For All and Single-payer system without much substance to those claims. By bringing together contrasting opinions on the need for reforms in the American healthcare system, the study brings the reader closer to the objective understanding of the realities of the current system and thus contributes to the formation of a more informed public perception. Coming at a time when the nation is fighting the COVID-19 pandemic, the study could not be more timely in illuminating the need for universal healthcare as reflected in the ideas of Medicare for All and Single-payer system, which could potentially address the diverse issues facing the current healthcare system and advance the idea of healthcare as a human right, not a privilege contingent on one’s biological or social identity.

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